[Comparative assessment of immediate results of mitral valve repair according to the classical technique with posterior leaflet preservation]. / Sravnitel'naia otsenka neposredstvennykh rezul'tatov protezirovaniia mitral'nogo klapana po klassicheskoi metodike s sokhraneniem zadnei stvorki.

We comparatively assessed the results of mitral valve repair according to the classical technique either with complete removal of leaflets or with the preservation of the posterior leaflet and the chordal-papillary apparatus. Depending on the variant of the operation, all patients were divided into two groups. Group One consisted of 23 patients in whom the posterior leaflet with the chordal-papillary apparatus was preserved, and Group Two comprised 23 patients in whom the mitral valve was removed completely. In the immediate postoperative period, Group One patients were found to have a decrease in the left ventricular end-systolic and end-diastolic dimensions and volumes. Similar dynamics was observed in relation to the left-atrial dimension, with a decrease in the pressure gradient across the mitral valve, pulmonary artery systolic pressure, and the degree of systolic shortening of the anterior-posterior size of the left ventricle. Group Two patients also demonstrated positive dynamics in relation to the left ventricular size and volume, the size of the left atrium and the right ventricle. The left-ventricular ejection fraction in the immediate postoperative period decreased averagely from 59.0±9.8% to 56.1±9.4%, accompanied and followed by a decrease in the pressure gradient across the mitral valve and pulmonary artery systolic pressure. The degree of systolic shortening of the anterior-posterior size of the left ventricle remained unchanged postoperatively. A conclusion was drawn that preserving the annulo-papillary continuity after mitral valve repair made it possible to achieve better functional results, normalization of the intracardiac haemodynamics, and improvement of the left-ventricle myocardial contractility. Complete removal of the subvalvular structures resulted in decreased contractility of the left ventricular myocardium.

[Surgical therapeutic decision-making in elderly patients with heart valvular defects combined with lesions of coronary and brachiocephalic arteries].

Due to considerable incidence of combined cardiac and vascular pathology in elderly and aged patients with heart valve defects, of special importance is the problem regarding surgical therapeutic decision-making. The present article is aimed at considering the problems concerning possibility and feasibility of stagewise or simultaneous surgical correction in patients diagnosed as having cardiac valve defect and haemodynamically significant lesions of coronary and/or brachiocephalic arteries based on generalizing the results of international studies.

[Surgical treatment of mitral and tricuspid valve defects]. / Khirurgicheskoe lechenie mitral'no-trikuspidal'nykh porokov serdtsa.

The results of surgical treatment of 265 patients with mitral-tricuspid valvular diseases are analysed. The operations were carried out in the period from Jan. 1, 1977 to Jan. 1, 1990 with various plastic procedures on the tricuspid valve. Hospital mortality was 13.2%. The late-term results were studied in follow-up periods of 6 months to 12 years in 207 (90%) patients. The results were good in 187 (75.9%), satisfactory and poor in 28 (13.5%) patients; 22 (10.6%) patients died. With the hospital losses taken into account, 5-year survival came to 73% and 10-year survival to 54%. Stability of good postoperative results was 79% by the 5th year and 49% by the 10th year. Among the surviving patients 85% are related to functional classes I and II and lead an active life. Plastic operations on the tricuspid valve can be undertaken in 92% of patients with mitral-tricuspid valvular diseases; they produce good late-term results in most cases, ensure stable normalization of hemodynamics, and should be performed more often in clinical practice.